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Pilomatrix Carcinoma of the Hand: A Case Report and Review of the Literature
Nallammai Muthiah, BS, Michael Marallo, MD, Elizabeth Moroni, MD, Meeti Mehta, BS, Casey Zhang, BS, Jignesh Unadkat, MD
University of Pittsburgh Medical Center
2022-01-19
Presenter: Michael Marallo
Affidavit:
The submitted project is original work of all listed authors and is the presenter's clinical patient and has not been published previously.
Director Name: Vu T Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Pilomatrix carcinomas are rare, locally-aggressive, malignant tumors derived from hair follicles. Fewer than 200 cases of pilomatrix carcinoma have been reported, most of which are tumors in the head or neck region. In this report we describe the presentation and clinical management of the first known reported case of pilomatrix carcinoma (without a sarcoid component) located on the hand.
Case Report: A 93-year-old Caucasian male veteran presented to dermatology clinic one year after noticing a lesion on the dorsum of his left hand. Physical examination revealed a 2 cm by 3 cm pink-to-erythematous, firm, non-friable nodule with central scaling over the dorsal left second metacarpal. Biopsy demonstrated dermal proliferation of basaloid matrical cells admixed with abundant shadow cells, and a Ki-67 of approximately 40%. These features were indicative of an atypical pilomatrical tumor. The lesion was excised under upper extremity block and intraoperative frozen pathologic specimens were suggestive of pilomatrical carcinoma. Final permanent pathology resulted with positive margins, yet the patient declined radiation therapy. The patient's most recent follow-up was 4 months after surgical excision at which point he declined further workup or treatment.
Conclusions: Pilomatrix carcinoma of the hand is a rare location for a rare tumor. Lesion resection, either via wide local excision or Moh's micrographic surgery, is the mainstay of treatment, and the decision for resection modality should be made on a case-by-case basis. However, tumor recurrence is common, and local recurrence is associated with distant metastases. Therefore, long-term clinical follow-up is vital to monitor patient outcomes.
